The Top Five Lethal Infections -- How to Prevent and How to Treat

Monday, Apr 18, 2011

In choosing the top five infections in which preppers should be well-versed, I have employed the following criteria: 

Based on the preceding, these five are a good place to start educating yourself.

PneumoniaPneumonia is often confused with bronchitis.  Both cause cough, fever, and difficulty breathing.  However, with bronchitis, the breathing tubes are narrowed, thus decreasing airflow.  Occasionally (primarily in patients with asthma or COPD) the airways will be so swollen that sufficient air cannot enter the lungs.  In these already-compromised patients, bronchitis may be life-threatening, but for the most part, acute bronchitis is self-limited and will resolve without antibiotics. In contrast, with pneumonia the tiny air sacs where gas exchange occurs are filled with infected fluid.  If fluid obstructs the membrane which allows oxygen to enter and carbon dioxide to escape our blood stream, the body may be deprived of life-giving oxygen.  Untreated, pneumonia is frequently life-threatening, especially in the elderly, the young, and those with other chronic breathing difficulties.  Sometimes bronchitis leads to pneumonia, or both problems can be present simultaneously (bronchopneumonia). 

As with most illnesses, there is a broad spectrum of pneumonia illnesses.  Some pneumonia is viral, and antibiotics do not help.  Pneumonia where only one lung is involved is usually bacterial and has a high enough fatality rate to warrant the use of antibiotics.  Untreated, the bacteria (commonly pneumococcus) may invade the blood stream, causing sepsis, widespread infection, and death.  Death may also occur from hypoxia (lack of oxygen causing suffocation).  It will be difficult for the layman to distinguish viral versus bacterial pneumonia (it’s difficult enough for doctors, who don’t always know either).  Diagnosing pneumonia by physical examination alone and distinguishing it from bronchitis is a whole article in itself, but one-sided chest pain is a strong argument for pneumonia in a patient with fever and cough.  (Blood clots, pleurisy, and heart problems may cause similar symptoms, however.)  Prevention of community-acquired pneumonia is 2-fold:  limiting spread via droplets and/or direct contact, and prevention of aspiration.  In the elderly, who have a decreased ability to clear their lungs, inhaling food particles or microbes frequently leads to pneumonia.  Having these folks eat slowly and remaining upright until the stomach clears after eating may decrease the likelihood of pneumonia.  Proper hand-washing for everyone and isolation of any infected patient should decrease the spread within the community. 

As for treatment, there is no single antibiotic guaranteed to work. What you have on hand may influence your choice of antibiotic.  Hospital doctors frequently prescribe IV medication, later switching to oral meds when the patient begins to improve.  You probably won’t have this luxury.  The strongest antibiotics (which you should probably reserve for the sickest patients) are Avelox, Levaquin, Biaxin, and Augmentin.  Appropriate first-line choices to treat pneumonia include erythromycin, clarithromycin, azithromycin, doxycycline, amoxicillin, and cephalexin.  Other possibilities include penicillin, ciprofloxacin, any cephalosporin, possibly trimethoprim-sulfamethoxazole or tetracycline.  The length of treatment is another concern.  Five days may be sufficient in a patient making a rapid recovery, but 7-10 days is more typical, and a very sick patient, or one with underlying asthma or COPD may require two weeks of continuous, full-dose therapy.  With a limited supply of antibiotics, rationing will likely be a necessity, and you’ll have to decide early on what criteria you plan to use.

Kidney infectionKidney infection (pyelonephritis) is primarily a disease of women and the elderly, and occasionally children.  Usually, but not always, kidney infection starts with a bladder infection, with symptoms of frequent urination, burning, or abdominal pain.  The bacteria may ascend the ureter and lodge in the kidney, commonly causing one-sided back pain, just under the lower posterior ribs.  Untreated, the bacteria create a cesspool of infection, which may enter the bloodstream, causing sepsis and death.  In older men, the underlying cause is often an enlarged prostate.  Elderly men and women (and sometimes younger people as well) with a kidney infection may not exhibit specific signs, but rather simply appear ill or not themselves. 
Prevention is aimed at cleansing the urinary system by drinking plenty of fluids.  Having a more-than-adequate supply of potable water may be life-saving for the patient prone to kidney infection.  Women should always empty the bladder after intercourse, and should never hold the urine when they feel the need to go.

Appropriate antibiotic treatment of kidney infection usually begins with trimethoprim-sulfamethoxazole, ciprofloxacin, or nitrofurantoin.  Again, Avelox, Levaquin, and Augmentin should probably be reserved for the sickest patients.  Amoxicillin is generally the first choice for pregnant women.  Cephalexin (or any cephalosporin) will usually work.  I generally don’t use penicillin, doxycycline, tetracycline, or the erythromycins, but they are sometimes effective.  Because nausea is a common symptom of kidney infection, it is best to avoid any antibiotic that has nauseated the patient in the past.  Duration of treatment should be about 5 to 15 days, with the shortest length of treatment reserved for those patients who seem to get well overnight.  If the chosen antibiotic has made zero difference by 3-4 days, a different antibiotic should be tried, generally one from a different class. 
      
Diverticulitis.  Diverticulitis is a disease of the middle-aged and elderly, those who have been on a western (American) diet long enough to have the little pouches bubble out (like tiny hernias along the colon), where food gets stuck and infection may occur.  The colon is chockfull of germs.  Normally the bacteria don’t have a chance to invade the wall of the colon during their transit along the gut, unless they get trapped in one of these pockets where an abscess-like infection may form.  If the pouch swells and bursts, the patient is a dead man (without emergency surgery and antibiotics).  You cannot wait this long to treat this infection.  There are no specific tell-tale signs, but the problem is more often left-sided than right, and is rare in people younger than about 35 or 40.  A little diarrhea or dark, maroon (bloody) stool may be present.  Urinary symptoms are generally absent.  Doctors themselves are not always sure if diverticulitis is present, but the risk of waiting outweighs the risk of treating when the diagnosis is suspected. 

Ideally prevention of diverticulitis begins in childhood with a lifelong diet high in plant fiber.  For anyone reading this article, your colon may already be riddled with the pouches (diverticula), so your best hope is to prevent the infection from starting.  Many patients find that eating popcorn or other small, hard objects sets off their symptoms (though this is medically controversial).  If I had diverticulitis, I would at least be meticulous about avoiding popcorn. 

Antibiotic treatment should ideally include a combination of metronidazole plus either ciprofloxacin (or Avelox, or Levaquin), trimethoprim-sulfamethoxazole, or possibly Augmentin.  Minimum length of treatment is one week, though two or even three weeks is sometimes necessary.

Clostridium difficile colitis.  Until we run out of antibiotics, we will continue to see c. diff. colitis, also known as antibiotic-related colitis.  This infection is very rare in patients who have not taken antibiotics, but more and more common in those who have.  It causes terrible diarrhea with an obnoxious odor, and may begin any time during or after a round of antibiotics.  Untreated, the infection can cause dehydration, sepsis, and death.  Prevention is aimed at limiting antibiotic use to those infections where antibiotics are essential.  The only readily-available oral drug for c. diff. is metronidazole.  Oral vancomycin is also effective, but much more costly. Conscientious hand-washing among patients and caregivers will help limit the spread of the disease.  As the use of antibiotics decreases, the incidence of c. diff. will decrease as well.

Cellulitis.  Lastly, cellulitis, or soft tissue infection, is theoretically almost entirely preventable.  As long as the skin is completely intact, without a scratch, blister, crack, or abrasion, cellulitis is quite rare.  But probably everyone reading this article has some little imperfection.  Looking at my own hands, I see a few tiny nicks, not to mention the dry skin caused by a long winter with forced-air heating.  A microscopic crack is sufficient to allow a microbe to invade, and the skin is always home to a variety of bacteria, usually non-virulent staph.  Upon invading the skin, the bacteria reproduce, causing either a localized pimple (or larger abscess, like a water balloon) or a more invasive infection, spreading through the tissues like a sponge.  The soft tissues in and under the skin swell, and become tender, red, and warm.  With cellulitis, the infection may spread to the lymphatic vessels or veins, enter the bloodstream, and, as with the diseases above, cause sepsis and death. Most cellulitis is caused by typical staph and strep germs, though other bacteria are not uncommon. 

The methicillin-resistant staph (MRSA) is a special problem.  Your main clue to its presence will be that drugs good for treating typical staph may not work. The best drugs for methicillin-resistant staph are currently trimethoprim-sulfamethoxazole or doxycycline.  For typical staph or strep, cephalexin or Augmentin are good choices.  The erythromycins and tetracyclines usually work as well.  Ciprofloxacin (as well as Avelox and Levaquin) are best reserved for cases in which none of the above antibiotics are effective, which may indicate infection with a gram-negative bacterium such as Pseudomonas.  Cellulitis should be treated for about 5 to 15 days, again with the shortest length of treatment reserved for those who respond within a day or two.  If the infection continues to spread after 24-48 hours (or hasn’t started to resolve the infection by 3-4 days) on a first-line antibiotic, therapy should be switched to that for methicillin-resistant staph.  If this makes no difference by 3-4 days, or if the infection continues to spread, switching to or adding ciprofloxacin is indicated.  If none of these therapies work, you might try combining all three, but odds of this working is really quite low, and treatment may be futile. 

In a future article I will address diseases common elsewhere in the world likely to spread in the U.S. if societal upheaval occurs.


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